de Sire A, Invernizzi M, Baricich A, Lippi L, Ammendolia A, Grassi FA, Leigheb M. Optimization of transdisciplinary management of elderly with femur proximal extremity fracture: A patient-tailored plan from orthopaedics to rehabilitation. World J Orthop 2021; 12(7): 456-466 [PMID: 34354934 DOI: 10.5312/wjo.v12.i7.456]
Corresponding Author of This Article
Massimiliano Leigheb, MD, PhD, Associate Professor, Chief Doctor, Orthopaedics and Traumatology Unit, Department of Health Sciences, University of Piemonte Orientale, Via Solaroli 17, Novara 28100, Italy. massimiliano.leigheb@med.uniupo.it
Research Domain of This Article
Orthopedics
Article-Type of This Article
Editorial
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Orthop. Jul 18, 2021; 12(7): 456-466 Published online Jul 18, 2021. doi: 10.5312/wjo.v12.i7.456
Optimization of transdisciplinary management of elderly with femur proximal extremity fracture: A patient-tailored plan from orthopaedics to rehabilitation
Alessandro de Sire, Marco Invernizzi, Alessio Baricich, Lorenzo Lippi, Antonio Ammendolia, Federico Alberto Grassi, Massimiliano Leigheb
Alessandro de Sire, Antonio Ammendolia, Department of Medical and Surgical Sciences, University of Catanzaro “Magna Graecia,” Catanzaro 88100, Italy
Marco Invernizzi, Alessio Baricich, Lorenzo Lippi, Physical Medicine and Rehabilitation, Department of Health Sciences, University of Piemonte Orientale, Novara 28100, Italy
Marco Invernizzi, Infrastruttura Ricerca Formazione Innovazione, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria 15121, Italy
Federico Alberto Grassi, Massimiliano Leigheb, Orthopaedics and Traumatology Unit, Department of Health Sciences, University of Piemonte Orientale, Novara 28100, Italy
Author contributions: de Sire A and Leigheb M contributed to study design and conceptualization; Lippi L contributed to database searching; de Sire A and Lippi L contributed to data synthesis and interpretation; de Sire A contributed to manuscript drafting; Leigheb M contributed to critical revision; Invernizzi M, Baricich A, Lippi L, Ammendolia A and Grassi FA contributed to visualization; Leigheb M contributed to study supervision and study submission; All authors have read and agreed to the published version of the manuscript.
Conflict-of-interest statement: The authors declare that they have nothing to disclose.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Massimiliano Leigheb, MD, PhD, Associate Professor, Chief Doctor, Orthopaedics and Traumatology Unit, Department of Health Sciences, University of Piemonte Orientale, Via Solaroli 17, Novara 28100, Italy. massimiliano.leigheb@med.uniupo.it
Received: March 23, 2021 Peer-review started: March 23, 2021 First decision: May 3, 2021 Revised: May 6, 2021 Accepted: June 4, 2021 Article in press: June 4, 2021 Published online: July 18, 2021
Abstract
Fractures of femur proximal extremity (FFPE) are the most common fragility fractures requiring hospitalization, with a high risk of mortality, low independence in the activities of daily living and severe consequences on health-related quality of life. Timing for surgery has a key role in the management of elderly patients with FFPE as recommended by the Australian and New Zealand guidelines and the National Institute for Health and Care Excellence guidelines. Early surgery (within 48 h from hospital admission) allows significant benefits in terms of lower rates of postoperative complications and risk of death and can provide better functional outcomes. Therefore, time for surgery could be considered as a comorbidity marker. The choice between conservative or surgical approach surprisingly seems to be still not strongly supported by available literature, but it seems that both 30 d and 1 year risk of mortality is higher with the conservative treatment rather than with surgery. In light of these considerations, the optimization of FFPE management care is mandatory to improve functional outcomes and to reduce sanitary costs. Albeit it is widely accepted that transdisciplinary approach to patients suffering from FFPE is mandatory to optimize both short-term and long-term outcomes, the feasibility of a comprehensive approach in clinical practice is still a challenge. In particular, the large variability of figures involved could be considered both a resource and an additional disadvantage taking into account the difficulty to coordinate multidisciplinary approach covering care in all settings. Therefore, the aim of the present article was to summarize current evidence supporting transdisciplinary management of patients with FFPE, highlighting the benefits, feasibility and limitations of this approach.
Core Tip: Optimization of fractures of femur proximal extremity management care is mandatory in order to improve functional outcomes and reduce sanitary costs. Albeit it is widely accepted that the transdisciplinary approach to patients suffering from fractures of femur proximal extremity is mandatory to optimize both short-term and long-term outcomes, the feasibility of a comprehensive approach in practice is still a challenge. Therefore, by the present study, we portray the potential benefits of transdisciplinary management of patients with fractures of femur proximal extremity, highlighting feasibility and limitations of this approach.
